title: Survival after liver transplantation using hepatitis C virus-positive donor allografts: case-controlled analysis of the UNOS database.
abstract: BACKGROUND
  Numerous reports have documented reduced graft and patient survival after use of hepatitis C (HCV) seropositive allografts in liver transplantation (OLT). We aimed to examine if the use of a HCV+ liver allograft affects patient and graft survivals compared to HCV- donor allografts in a case-controlled analysis of the united network for organ sharing (UNOS) database.
  
  
  METHODS
  We examined 63,149 liver transplants (61,905 donors HCV-; 1,244 donors HCV+) from the UNOS standard transplant analysis and research (STAR) file from 1987 to 2007. Donor and recipient demographics and outcomes were collected in which donor HCV serology was complete. A case-controlled cohort from 11 donor and recipient variables comparing donor HCV- and HCV+ allografts (n=540 in each group) was created using propensity scores with a matching algorithm. Graft and patient survival was estimated using Kaplan-Meier survival curves.
  
  
  RESULTS
  Significant differences were evident in the unadjusted cohort between recipients who received HCV+ and HCV- allografts, including HCV+ recipients, donor and recipient age, and model for end-stage liver disease (MELD) exception cases. Use of HCV+ allograft resulted in significantly lower graft survival (8.1 vs. 10.6 years; P=0.001) and patient survival (10.2 vs. 12.3 years; P=0.01) after OLT. In the matched cohort, HCV seropositivity had no detrimental effect on the graft (P=0.57) or patient (P=0.78) survival after OLT.
  
  
  CONCLUSIONS
  This is the first population-based analysis to show that after adjusting for donor and recipient characteristics there was no difference in graft or patient survival with the use of HCV+ donor liver allografts compared to HCV- donor liver allografts.
authors.affiliation: Department of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, MA 01655, USA.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Burr
authors.forename: YouFu
authors.initials: Y
authors.lastname: Li
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Tseng
authors.forename: Reza F
authors.initials: RF
authors.lastname: Saidi
authors.forename: Adel
authors.initials: A
authors.lastname: Bozorgzadeh
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D006526:Hepatitis C; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors